High fives, standardisation and emotions

In the middle of September, on a warm late summer’s evening in Staffordshire, a gathering of people came to find out a little more about LfE. Sponsored by the WMAHSN, this was also a chance to share – experiences, knowledge, successes as well as concerns – about starting or developing projects which facilitate the communication of appreciation of the ‘everyday excellence’ of frontline healthcare work. Whilst this is a determinedly positive approach, it is conducted in the knowledge that there are necessary constraints when working within healthcare organisations. Risk and uncertainty are ever-present reminders that ‘things could go wrong’. But the ‘reality’ is that healthcare professionals don’t enter into this demanding work intending for such ‘things’ to happen.

Management of risk takes many forms, but one approach that remains high profile in any risk-laden sector is standardisation. This usually takes the form of the standardisation of operational procedures using protocols and pathways. Influenced by sectors characterised by high reliability organisations, healthcare has caught the standardisation ‘bug’.

The reason for mentioning this? Rather than drifting off topic, it is actually central to my purpose. At the LfE event in Stoke, standardisation was raised as key to patient safety efforts. A questioner legitimately wondered out loud whether projects like LfE might be missing the point of the importance of something as significant as standardisation. Surely, the standardisation of ‘good practice’ just means the same thing as that work proposed by LfE? Part of Dr Adrian Plunkett’s response was that whilst there was a truth to this, the standardisation of appreciation for excellent work – that is, perhaps, of good practice under conditions of stress and strain in the system – might just be one of the things missing from healthcare. And therefore, by extension, that this adds something to patient safety that is not accounted for by the standardisation project.

Nearly a decade ago the World Health Organisation (WHO) set out the ‘High 5s’ – five key areas within healthcare identified as significant weak-points in relation to patient safety deemed likely to benefit from standardisation. The areas included hand hygiene, medication and surgical management, as well as clinical handover communication. In a recent review of movement towards globally-applicable Standard Operating Protocols (SOPs), Agnes Leotsakos and her colleagues reported upon some of the successes and the challenges which have emerged. Inevitably, concessions have had to be made (e.g. not all of the five areas of work were amenable to SOPs) and the final report isn’t yet available (it’s due imminently, in late 2016). However, even though the work was commenced in 2007, they claim this approach to quality and safety in healthcare is still in its early stages. This isn’t disappointing; rather, it’s realistic and seems to align with the experience of planning, delivering and evaluating frontline healthcare in the face of patient safety concerns. It takes time, but those involved believe it can be done.

Patient safety is itself a complex endeavour. Interest is beginning to be directed more systematically towards the emotional element of patient safety work. Heyhoe and her colleagues have recently offered a clear framework for understanding at least some of these elements. In taking a balanced perspective, they include both ends of the valence spectrum i.e. positive as well as negative emotions. Emotion, they suggest, can impact upon decision-making, patient outcomes as well as how clinicians approach and understand their work. The broader literature and evidence-base is building to give even more support to this take on healthcare.

And so, rather than seeing the work of initiatives such as LfE as being in some way a deviation or distraction from the agenda which is driving towards standardisation, there is another view. Recognising, supporting and appreciating the excellence evident in the everyday work of healthcare professionals can contribute towards positive emotions in and around that vital work. And this then augments and supports ‘good’ processes in patient safety work. It may even contribute towards the unlocking of a deeper understanding of the obstacles still being faced in attempting to introduce and implement standardisation in healthcare. As Leotsakos herself states, SOPs are a part of the process which itself recognises and advances excellence in healthcare practice.

LfE and standardisation aren’t then, if you are open to considering this perspective, in any way in opposition. They aren’t even just working (separately) towards the same goal. They are mutual and interdependent. Adrian was – and is – onto something ‘big’ here!